Biomedical subjects
Publications and source records attributed to N Kitamura.
Setleis' syndrome is an uncommon inherited condition characterized by bilateral "scarlike" depressions on the temples and a wide spectrum of associated facial abnormalities. We report on a typically affected Japanese boy, whose mother and grandfather show a much milder expression of this disorder, suggesting an apparent autosomal dominant inheritance.
A chemiluminescence (CL) procedure was developed to determine the time course of the release of myeloperoxidase (MPO) from activated human neutrophils using two CL probes, luminol, and MCLA. Luminol-dependent CL (LDCL) and MCLA-dependent CL (MDCL) in a hypoxanthine (HX)/xanthine oxidase (XOD) system, both of which were completely inhibited by superoxide dismutase, were a linear function of the XOD concentration, with the relationship formula being LDCL = 0.003 x MDCL. Under the same conditions, MPO could enhance LDCL in a dose-dependent manner, without influencing MDCL. There was a linear correlation between the MPO concentrations and the values of (LDCL-0.003 x DCL) (coefficient of correlation = 0.004). This correlation made it possible to determine the release of MPO in the neutrophil/stimulus system by simultaneously monitoring the generation of LDCL and MDCL. By this CL procedure, it was revealed that there were variations in both neutrophil MPO releasing patterns and levels depending on the stimulating agent used.
The stomach of the lesser mouse deer was studied at the light microscopic level using histological and immunohistochemical methods. The stomach was clearly differentiated into rumen, reticulum including reticular groove, a small transition zone and abomasum. The mucosal surface of the rumen, reticulum and transition zone was lined with a stratified squamous epithelium and that of the abomasum with a simple columnar type. The epithelial keratinization was weak in the rumen, floor of the reticular groove and transition zone, while it was strong in the reticulum, especially on the tip of the reticulum papillae. Large sinusoidal capillaries were often present in the ruminal papillae. In the ruminal mucosa, a thin layer of alpha-smooth muscle actin immunoreactive cells was demonstrated by immunohistochemistry. The muscularis mucosae of the reticulum was continuous and well-developed. The transition zone appeared as a nonglandular area having many low mucosal folds and two layers of tunica muscularis. The abomasal mucosa consisted of cardiac, proper gastric and pyloric glands. Cells immunoreactive for bovine pepsinogen and bovine prochymosin antisera were demonstrated in the abomasum. It is suggested that the characteristic features observed might be adaptations to a relatively rapid passage and rapid absorption of the fermentation products. There is some evidence that the transition zone is not a part of either the floor of the reticular groove or the abomasum, suggesting a possible reevaluation of the term used for the reticulo-abomasal orifice in the mouse deer.
A 50-year-old male with Buerger's disease underwent coronary artery bypass grafting (CABG) using left and right internal thoracic arteries (LITA and RITA). In our case, his saphenous veins could not be used because of migrating thrombophlebitis, and we could not use right gastroepiproic artery because he had undergone gastrectomy for gastroduodenal ulcer. He underwent CABG with LITA-left anterior descending artery and free RITA-right coronary artery. Postoperative coronary angiogram showed good patency of both grafts, and his postoperative course has been uneventful for 42 months. To our knowledge, there is no report of CABG in a patient with Buerger's disease, but we think the use of arterial grafts is useful in such cases.
A 39-year-old woman with the diagnosis of mitral regurgitation was admitted to our hospital for surgical treatment. Cerebral thromboembolism and spontaneous abortion had been repeated in her past history. She was suffered from chronic renal failure associated with systemic lupus erythematosus (SLE) and anti-phospholipid syndrome (APS). An operative procedure was recommended because of the progressive heart failure due to mitral regurgitation. For renal failure, continuous ambulatory peritoneal dialysis (CAPD) was introduced at one month before operation. As the operative procedure, valve replacement using Carpentier-Edwards bioprosthesis (27 mm) was done rather than valve reconstruction, because chordal rupture of posterior leaflet and severe hypertrophy of both leaflets were recognized. During operation, uncontrollable bleeding was not observed. However, platelet transfusion was needed. We use warfarin and antiplatelet agents jointly as postoperative anticoagulant therapy. Thromboembolic episodes have not been observed 4 years postoperatively. Relationship between SLE with APS and cardiac valvular lesions has been focused. The present case was considered to be the interesting case which various devices were necessary to operative management including chronic renal failure, cardiopulmonary bypass, selection of prosthetic heart valve, and postoperative anticoagulant therapy for preventing thrombus formation.
The patient was a 43-year-old woman who had undergone mitral valve replacement with Starr-Edwards ball valve (model 6320) 22 years ago. Perivalvular mitral leakage due to prosthetic valve endocarditis and tricuspid regurgitation were found. She underwent re-replacement of the mitral valve. The operative findings revealed almost intact valvular function of the ball valve. As far as we know, 22 years is the longest follow-up for the Starr-Edwards ball valve which has maintained normal function.
The development of progastricsin-immunoreactive cells in the abomasal mucosa of cattle fetuses was studied by immunohistochemistry. Progastricsin-immunoreactive cells were detected first in the fundic and pyloric regions of 52 cm in crown-rump length (CRL) fetuses (about 180 days of gestation). The frequency of occurrence of progastricsin-immunoreactive cells and the intensity of their immunoreactivity increased with the progress of gestation, but most of these immunoreactivities were restricted to the basal portion of the fundic and pyloric glands. After birth, in the fundic mucosa, progastricsin immunoreactivities were found not only in the chief cells but also in the surface mucous cells of the gastric pits. In the cow, the immunoreactivity of the surface mucous cells was even stronger than that of the chief cells. In the pyloric mucosa, progastricsin immunoreactivities were found in the gastric pits and in the basal portion of the pyloric glands, but they were organized in small groups and showed a patchy distribution in the basal portions.
We have proposed Rasping procedure as one of the methods of aortic valvuloplasty (A-Rasping) and defined as debridement of the thickened surface of the rheumato-degenerative aortic valve using an electric rasper since 1986. Furthermore, we have extended this technique to mitral valvuloplasty (M-Rasping). The purpose of this study is to evaluate intermediate to late results of valvuloplasty by Rasping procedure. From 1986 to 1994, this method was carried out on 14 patients with mild-to-moderate aortic valve disease in severe mitral valve disease or coronary artery disease, and on 6 patients with mitral stenosis. In A-Rasping group, aortic regurgitation was found in 10 patients and aortic stenosis was found in 4 patients. The degree of regurgitation, the transvalvular pressure gradient, and the pre- and postoperative cardiac function in both group were investigated chronologically by echocardiography. In this series of patients, no hospital mortally including operative death was observed. Furthermore, reoperation for repaired aortic or mital valve was not required. In A-Rasping group, 2 late deaths (14.2%) occurred at 1 year and 4 years after operation. Cause of 2 late deaths was prosthetic valve endocarditis in mitral position. In A-Rasping group, at 1 year after operation, regurgitation was reduced to degree I or less in all patients. However, at the 3rd postoperative year, regurgitation increased to degree II in 2 patients. As compared with the preoperative values, the transvalvular pressure gradient significantly decreased in 4 patients (29.5 +/- 7.6 mmHg vs 12.5 +/- 5.0 mmHg, p = 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)
From April 1992 through July 1994, 7 patients underwent mitral valvuloplasty using rasping procedure in conjunction with open mitral commissurotomy. All patients had satisfactory postoperative results without the complications such as restenosis, regurgitation, infection. However, thromboembolism was observed in 1 patient at the postoperative 6 months. And no reoperation for repaired mitral valve was observed. Transvalvular pressure gradient significantly decreased from 14.3 +/- 8.5 mmHg to 4.7 +/- 1.6 mmHg after operation. Mitral valve areas significantly increased from 1.01 +/- 0.31 cm2 to 1.78 +/- 0.41 cm2 after operation. As compared with preoperative value of 0.32 +/- 0.02, postoperative left ventricular fractional shortening (LVFS) significantly improved to 0.40 +/- 0.03. The advantages of this method is considered to be equable and safe débridement, and no anticoagulation at late period. Mitral valvuloplasty using rasping procedure, except for transmural calcified lesions, is useful and effective method. And excellent postoperative long-term results could be expected.
A magnetic resonance imaging (MRI) examination has reportedly produced psychological distress such as discomfort, anxiety and fear in a certain number of patients. In an attempt to prevent such distress during an MRI, the authors took the following psychological measures: 1) improved psychological support for patients by MRI technicians; 2) providing sufficient information to patients about the imager and the nature of the examination; 3) reassurance of the safety, with the patient free to terminate the examination at any time; 4) environmental modification to induce relaxation, including recorded music, paintings and live plants in the examination room. We then evaluated the effectiveness of these combined psychological support factors for all MRI patients. A questionnaire on psychological distress experienced during an MRI was filled out by 143 patients (mean age, 49.4 years) and 105 patients (mean age, 48.4 years) prior to and after our psychological measures, respectively, after MRI test in Saiseikai Nakatsu hospital, and comparisons made between these two groups (chi 2 test, p < 0.05). The number of patients experiencing psychological distress during an MRI was significantly decreased (50.5%) after the measures were implemented as compared to the number (64.3%) beforehand. In particular, female, 60 or older patients and patients examined for the first time showed significant decreases in experiencing psychological distress after the measures were implemented. The number of patients who reported distress, tended to decrease. Patients who developed certain symptoms, such as palpitation, also tended to decrease. Patients who reported the "long examination time" as a distress factor and those who developed palpitation during the examination significantly decreased. Our results indicate that these combined psychological measures are efficacious in reducing psychological distress during an MRI, mainly by curtailing the patient's subjective sense of examination time. In addition to an MRI examination, our psychological measures should be applied to other medical examinations which tend to generate undue psychological distress.
Composite graft replacement of the ascending aorta and aortic valve has been indicated for aortic regurgitation (AR) associated with annulo aortic ectasia (AAE). 29-year-old female with AR due to AAE associated with Marfan's syndrome underwent the replacement of ascending aorta by sparing an aortic valve with good result. Under cardiopulmonary bypass, the proximal ascending aorta was dissected circumferentially down to the ventriculo-aortic junction. The aneurysmal aorta and the all three sinuses of valsalva were excised, leaving 7 mm of arterial wall attached to the aortic valve and small buttons of arterial wall around the both left and right coronary arteries. The aortic valve was reimplanted inside a 28 mm Dacron graft which was calculated by aortic valve leaflet height. The left coronary artery was reimplanted to the graft by interposing a short 10 mm Dacron graft between coronary ostia and graft and the right coronary artery was anastomosed directly to the graft (Piehler's procedure). We called these procedure "modified David's operation". The patient has survived the operative procedure without any complications. Postoperative aortogram showed a competent aortic valve and the peak systolic pressure gradient across the aortic valve was 20 mmHg. We believe this new procedure preserving the native aortic valve is useful for preventing from some complications associated with artificial heart valves.
A 69-year-old man was transferred to our hospital because of severe progressive heart failure, eyeground hemorrhage due to embolism and uncontrollable inflammation. Emergent operation was suggested. Aortic valve replacement with a 23 mm Carpentier-Edwards bioprosthesis and patch closure of perforation using Dacron double velore was successfully performed. Vegetation was observed from the commissure between left and non coronary cusp to the aortic wall. Perforation (3 mm in diameter) and a moderate amount of bloody pericardial effusion were recognized. However periannular abscess was not detected. Postoperative course was uneventful and no recurrence of infection has been seen. We believe that surgical treatment for active infective endocarditis should be recommended when the bactericidal agents are ineffective and before the hemodynamics is suddenly deteriorated and the embolism occurs to the other organs.
A 44-year-old man suffered from an traffic accident on May 27, 1994. He was transferred to a hospital because of emergent operation for a laceration of liver, right-sided hemothorax and pneumothorax. After surgical treatment for these lesions, he was doing well. However, systolic murmur appeared from August, 1994. By echocardiography and cardiac catheterization, he was diagnosed of isolated tricuspid regurgitation due to traumatic ruptured papillary muscle. Because right heart failure was progressive, an operation was recommended. At operation, annular dilatation of tricuspid valve and ruptured papillary muscle of anterior leaflet were found. And the ruptured end of right ventricular aspect was recognized. Therefore, we performed tricuspid valvuloplasty and annuloplasty. Postoperative course was uneventful. And residual regurgitation was not detected by right ventriculography. Especially, in patients with tricuspid regurgitation due to ruptured papillary muscle, symptoms usually begin soon after trauma. Therefore, an operation should be recommended promptly in the presence of right heart failure not relieved by medical treatment. And an earlier operation could increase the feasibility of tricuspid valvuloplaty, and the possibility of maintaining sinus rhythm.
A multi-institutional cooperative study, that was a comparison of long-term results of the replacement of the four models of the oblique disc valve prosthesis which had been implanted on aortic and mitral position alone or double from December 1976 to September 1992 in the eight national hospitals in Japan was performed. Seven hundred and thirty-four patients and 765 prostheses that consisted of 582 patients and 610 prostheses of the Björk-Shiley (BS) valve, including 326 patients of the Spherical disc (SP) valve (49 aortic, 259 mitral, and 18 double aortic-mitral), 103 patients of the Convexoconcave disc (CC) valve (45, 51, 7) and 153 patients of the Monostrut (MS) valve (101, 49, 3), and of 152 patients (71, 78, 3) and 155 prostheses of the Omnicarbon (OC) valve were compared with their mortality and morbidity in every valve position respectively according to the approval by STS-guideline. The MS valve and the OC valve showed 0% to 11.3% of operative mortality, 0.3%/py to 1.8%/py of valve related mortality, 85.5% +/- 5.6% to 98.4% +/- 1.6% of actuarial survival rate at 10 years, and 58.5% +/- 6.4% to 82.7% +/- 5.7% of actuarial free rate of all mortality and morbidity at 10 years in every valve position. Structural deteriorations occurred in two patients of the CC valve in the mitral position only, and its rate of all valve positions showed 0.04%/py. Significant differences were seen in actuarial survival rate at 10 years after aortic valve replacement, and in operative mortality rate, improved degree of NYHA class, structural deterioration rate and actuarial free rate of all mortality and morbidity after mitral valve replacement between the group of the MS and OC valve and the group of the SP and CC valve. Therefore the MS valve or the OC valve should be selected to implant rather than the SP valve or the CC valve, and the patient who had been implanted with the CC valve should be treated considering valve position, valve position, valve size, age and activity of the patient and the manufactured date of the prosthesis.
The dorsal lingual papillae of the lesser mouse deer were studied morphologically using light and scanning electron microscopy. Four types of papillae, filiform, fungiform, vallate and foliate, were observed. Filiform papillae consisted of larger main papillae with smaller secondary papillae on their anterolateral aspects. Secondary papillae were well distributed over the anterior two-thirds of the tongue, but were very rare or absent in the posterior third. Fungiform papillae were distributed among the filiform papillae, being larger and more abundant on the tip of the tongue. Vallate papillae were round-flat or long-flat, surrounded by a prominent circular groove and a thin annular pad. An important finding was the presence of distinct and prominent foliate papillae on the posterolateral sides of the tongue. Keratinisation of the covering stratified squamous epithelium was relatively weak. Taste buds were observed in the epithelium of the fungiform, vallate and foliate papillae. The lingual papillae of the lesser mouse deer showed some characteristics that differed from those reported for domestic ruminants. These may be related to the feeding habits and the type of food eaten by this species.
A hepatitis-C-associated microtubular aggregate protein, referred to as p44, has been identified as a cytoplasmic antigen in the hepatocytes of chimpanzees infected with hepatitis C virus. The production of p44 mRNA is markedly induced in the liver of chimpanzees infected with hepatitis C or hepatitis D virus. To examine the mechanism of this induction, we isolated a genomic clone for the human p44 protein and analyzed its structure. The human p44 gene spans approximately 14 kbp of DNA and consists of nine exons separated by eight introns. An interferon-stimulated response element, which confers inducibility by interferon-alpha/beta, was found in the promoter region of the gene. Northern-blot analysis revealed that the human p44 gene is inducible by interferon-alpha/beta, but not by interferon-gamma. Functional analysis demonstrated that the interferon-stimulated response element in the promoter region of the gene mediates the inducibility of the gene by interferon-alpha/beta. Thus, the human p44 gene is a member of the family of interferon-alpha/beta inducible genes. The protein p44 may be one of the mediators involved in the antiviral action of interferon.
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Ligand-induced tyrosine kinase activation of the scatter factor/hepatocyte growth factor receptor (c-Met) is thought to be essential for the biological responses of target cells. To assess the regulatory role of the major tyrosine autophosphorylation site (tyrosine 1233) of the mouse c-Met receptor in the tyrosine kinase activation of the receptor, we constructed a mutant receptor in which the tyrosine residue was replaced with phenylalanine. When the cells expressing the mutant receptor were incubated with the ligand, no biological responses were observed, and the level of tyrosine phosphorylation of the receptor was very low compared with that of the wild-type receptor. The in vitro kinase activity of the mutant receptor toward an exogenous substrate and the receptor itself was also low. Furthermore, tyrosine phosphorylation of the cellular proteins by ligand stimulation was not detected in intact cells expressing the mutant receptor. The low level of kinase activity and the lack of biological activity of the mutant receptor indicate that the major autophosphorylation site positively regulates the tyrosine kinase of the c-Met receptor and phosphorylation of cellular substrates in the scatter factor/hepatocyte growth factor signaling pathway.